MD Need help choosing specialty - Gen Surg vs Peds (NICU specifically)

[xALIAx]

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Hello all

Finishing up M3 and am having trouble deciding what specialty to apply to.

I hated IM with a passion and had surgery rotation right after. Pretty much enjoyed every day of my surgery clerkship. particularly enjoyed urgent+trauma surgery rotation and decided I was going to become a rural general surgeon.

What draws me to Peds is only Neonatology. I had not done Peds yet but have shadowed in NICU. My interest stems from the patient population - I struggled a lot in both IM and Gen Surg with disliking a lot of my patients (because I perceived them as either being demanding, annoying, and/or having put themselves in their situation) This feeling was more so in IM but did occur in Gen Surg. The patient population in NICU just seems very gratifying to work with in comparison (although I am sure family social issues are a whole separate issue)

When I shadowed in the NICU I just felt like it was everything I envisioned medicine as being before Internal medicine crushed that perception. You have to know your physiology, your pharm, your micro in NICU because the babys desparately need you to. Often times on IM I questioned what the point of knowing all that stuff was.

Watching a chest tube get put into a 26 weeker with a tension pneumo was incredible - watching the same procedure on a gomer on IM wanted to make me pull my hair out.

The NICU had an incredible amount of optimism, from decorations of baby names to pictures of babies who had gone on to enter their teens and 20s. IM on the other hand felt like the bowels of a hospital.


tl;dr:

Gen Surg Pros:
- surgery is cool and i like the OR
- could see myself enjoying my work as a rural general surgeon, or a urgent/trauma surgeon in an urban setting
- definitely felt that the surgery attendings and residents were most similar to me personality wise
- honored it, which i take to mean I show at least some promise in the field

Gen Surg Cons:
- difficult residency
- not great lifestyle afterwards
- i hate the mundane Gen Surg BS such as abscess drains, inheriting trainwrecks from other crappy surgeries, and talking about J tubes vs GJ vs DHT tubes and butt pus almost as much as IM
- annoying elitist culture of the OR floor

NICU Pros:
- cannot imagine a patient population who I would feel more honored and gratified to serve than neonates
-i think attending lifestyle is better than a general surgeon's (but apparently its still not great amongst peds )
- peds residency is cush af
- ties together everything i thought medicine is supposed to be. many good outcomes due to a lot of hard work, some awful outcomes despite a lot of hard work, talking through difficult conversations at family meetings

NICU cons:
- have to suffer through 3 years of pediatrics residency (i generally hate the "medicine" sideof medicine such as long rounding, well person exams, social issues, extensive problem lists etc)
- doctors dont seem as respected in the NICU as compared to surgeons in the OR (although this may soudn petty at first, please see the posts by residents in the Peds forum about how nurses treat them terribly on their NICU rotations)
- easier to automate since it has more thinking than doing

The other consideration I am having is going for pedatric surgery but this would be a decade long training after graduation and not guaranteed to get it.

Thanks for your thoughts.

 

[Spodermin]

The other consideration I am having is going for pedatric surgery but this would be a decade long training after graduation and not guaranteed to get it.

Are you guaranteed a neonatology fellowship? Are you guaranteed finding your ideal job as a general surgeon? Are you guaranteed anything in medicine? The answer is always no.

Pick a specialty where you would be happy to deal with the bread and butter cases.

 

[Dr G Oogle]

Why not do a surgical subspecialty and the do a peds fellowship or even anesthesia and then peds anesthesia

 

[lalalaaaaaa]

Why not do a surgical subspecialty and the do a peds fellowship or even anesthesia and then peds anesthesia

Peds surg sounds like a good option of OP except that if you seriously consider peds surgery, you need to have an AMAZING application and go to an excellent residency. It's super super competitive. You need excellent research including taking 1 or 2 years off during residency to do as much research as possible. You also need to get through gen surg residency.

Do a sub-i in both fields during 4th year. You need more experience beyond shadowing in the NICU. NICU has a TON of medicine. You might not have seen or appreciated that if you weren't following patients during a rotation.

 

[OrthoTraumaMD]

So you hate the “elitist structure” of the OR but are worried about not being “respected” enough as a pediatrician? Hmmm....

Also, the mundane part of any specialty comprises the majority of the work. If you hate that part of surgery, don’t be a surgeon.

 

[Tenk]

Nurses treat residents terrible who they feel will harm their patients or they just don’t like. Doesn’t matter what specialty you are in. I’ve befriended almost every single nurse I’ve ever worked with (even ones all the other residents hate). Just takes work like anything else and good social skills.

You aren’t listing the actual negatives about neonatology:
1) drug parents
2) overall poor social situation
3) patient deaths

While 3) is very rare, 1) and 2) are not and sometimes 3 can be career ending. I’d be more worried about these things than having a nurse yell at you while you are a resident.

 

[longhaul3]

Is an adult with a tension pneumo really a gomer?

NICU is pretty cool but there is no extrinsic prestige in peds since you mentioned it—most people revere the NICU nurses over all, especially the lay public.

 

[Tenk]

Is an adult with a tension pneumo really a gomer?

NICU is pretty cool but there is no extrinsic prestige in peds since you mentioned it—most people revere the NICU nurses over all, especially the lay public.

No. I’d take one of those in my ED any day.

 

[xALIAx]

Are you guaranteed a neonatology fellowship? Are you guaranteed finding your ideal job as a general surgeon? Are you guaranteed anything in medicine? The answer is always no.

Pick a specialty where you would be happy to deal with the bread and butter cases.

TBH you are kinda guaranteed to match NICU or become a rural general surgeon if you want those things. i think i would be happy with the bread and butter of both

Why not do a surgical subspecialty and the do a peds fellowship or even anesthesia and then peds anesthesia

Anesthesia is a hard no for me. None of the surgical subs stand out as interesting to me

Peds surg sounds like a good option of OP except that if you seriously consider peds surgery, you need to have an AMAZING application and go to an excellent residency. It's super super competitive. You need excellent research including taking 1 or 2 years off during residency to do as much research as possible. You also need to get through gen surg residency.

Do a sub-i in both fields during 4th year. You need more experience beyond shadowing in the NICU. NICU has a TON of medicine. You might not have seen or appreciated that if you weren't following patients during a rotation.

thanks, yeah I will have to do a NICU elective and surgery sub-I right away in 4th year

So you hate the “elitist structure” of the OR but are worried about not being “respected” enough as a pediatrician? Hmmm....

Also, the mundane part of any specialty comprises the majority of the work. If you hate that part of surgery, don’t be a surgeon.

hating the snobby culture of the OR floor and wanting to be treated with respect and not undermined by hostile nurses are not mutually exclusive things

Nurses treat residents terrible who they feel will harm their patients or they just don’t like. Doesn’t matter what specialty you are in. I’ve befriended almost every single nurse I’ve ever worked with (even ones all the other residents hate). Just takes work like anything else and good social skills.

You aren’t listing the actual negatives about neonatology:

1) drug parents
2) overall poor social situation
3) patient deaths

While 3) is very rare, 1) and 2) are not and sometimes 3 can be career ending. I’d be more worried about these things than having a nurse yell at you while you are a resident.

thanks a lot for these insights. could you elaborate on why #3 can be career ending? a personal emotional grief or some sort of malpractice?

Is an adult with a tension pneumo really a gomer?

NICU is pretty cool but there is no extrinsic prestige in peds since you mentioned it—most people revere the NICU nurses over all, especially the lay public.

\
yeah i meant like pneumocentesis for malignant lung cancer

and yeah, the nurses sure have a strong PR arm

 

[OrthoTraumaMD]

OR culture is not snobby. It’s hierarchical. The “respect” you care about is a version of the same thing.

 

[xALIAx]

OR culture is not snobby. It’s hierarchical. The “respect” you care about is a version of the same thing.

great, thanks for your input. highly appreciated.

 

[OrthoTraumaMD]

great, thanks for your input. highly appreciated.

Sarcasm in response to advice doesn’t look good. Ciao.

 

[Matthew9Thirtyfive]

great, thanks for your input. highly appreciated.

She’s not wrong. Yes there are jerks in the OR, but there are jerks in every area of the hospital. The OR is a very hierarchical place for a reason. Being at the bottom of the totem pole is not the same as being disrespected. It’s okay to not like the hierarchy, but that’s in every OR in the country basically, so you might have a frustrating time as a resident.

 

[Tenk]

TBH you are kinda guaranteed to match NICU or become a rural general surgeon if you want those things. i think i would be happy with the bread and butter of both



Anesthesia is a hard no for me. None of the surgical subs stand out as interesting to me


thanks, yeah I will have to do a NICU elective and surgery sub-I right away in 4th year



hating the snobby culture of the OR floor and wanting to be treated with respect and not undermined by hostile nurses are not mutually exclusive things


thanks a lot for these insights. could you elaborate on why #3 can be career ending? a personal emotional grief or some sort of malpractice?


\
yeah i meant like pneumocentesis for malignant lung cancer

and yeah, the nurses sure have a strong PR arm

Usually the first. Dead kids suck. Dead babies suck more.

 

[differentiating]

How have you finished third year but not rotated on peds? I'd recommend doing a peds rotation before making any decisions about whether or not you'd enjoy neonatology - it's different in a lot of ways to IM, and you yourself note that you enjoyed procedures in neonates that you hated in adults. I also agree with the above that you seem to be glossing over the real cons of a career in neonatology.

 

[xALIAx]

She’s not wrong. Yes there are jerks in the OR, but there are jerks in every area of the hospital. The OR is a very hierarchical place for a reason. Being at the bottom of the totem pole is not the same as being disrespected. It’s okay to not like the hierarchy, but that’s in every OR in the country basically, so you might have a frustrating time as a resident.

I understand Surgery culture is hierarchical for medical students, physicians in training, and attendings. I like that, actually. What i am talking about is the snobbiness of the scrub techs and OR nurses who often treat residents and students terribly

How have you finished third year but not rotated on peds? I'd recommend doing a peds rotation before making any decisions about whether or not you'd enjoy neonatology - it's different in a lot of ways to IM, and you yourself note that you enjoyed procedures in neonates that you hated in adults. I also agree with the above that you seem to be glossing over the real cons of a career in neonatology.

Finishing up M3 and am having trouble deciding what specialty to apply to.

 

[Matthew9Thirtyfive]

I understand Surgery culture is hierarchical for medical students, physicians in training, and attendings. I like that, actually. What i am talking about is the snobbiness of the scrub techs and OR nurses who often treat residents and students terribly

*shrug* I've worked at hospitals in 3 states and have never experienced that. I'm sure it happens, but some of it might be med students being a little too sensitive to the hierarchy.

 

[differentiating]

Based on that phrasing, I assumed you meant that you had 1-2 weeks at most left, not that you had at least one whole rotation left to go. But nevertheless, the point still stands. It's premature to be making this decision before you've even experienced one of the two specialties involved.

 

[xALIAx]

Based on that phrasing, I assumed you meant that you had 1-2 weeks at most left, not that you had at least one whole rotation left to go. But nevertheless, the point still stands. It's premature to be making this decision before you've even experienced one of the two specialties involved.

yeah the problem is peds is very different from NICU and my peds rotation ends concernigly close to eras, giving me very little time to do both a surgery subI and a nicu subI before 9/15

 

[differentiating]

yeah the problem is peds is very different from NICU and my peds rotation ends concernigly close to eras, giving me very little time to do both a surgery subI and a nicu subI before 9/15

You’ll probably do some NICU on peds. That being said, I don’t think they’re as different as you make them out to be.

When does your rotation end? I finished 3rd year by May and had time for 3-4 sub-Is prior to applying. In terms of scheduling, it’s probably best to plan on doing both for now so you don’t lock yourself out of one or the other prematurely.

 

[xALIAx]

You’ll probably do some NICU on peds. That being said, I don’t think they’re as different as you make them out to be.

When does your rotation end? I finished 3rd year by May and had time for 3-4 sub-Is prior to applying. In terms of scheduling, it’s probably best to plan on doing both for now so you don’t lock yourself out of one or the other prematurely.

i dont get as much time. do you know if you have to have a surgery subI done before 9/15 if applying surgery?

 

[differentiating]

i dont get as much time. do you know if you have to have a surgery subI done before 9/15 if applying surgery?

I would guess that surgery would care more about it being done before 9/15 than peds based on what classmates have said. It may make getting letters more complicated, though.

 

[MerYangBey]

*shrug* I've worked at hospitals in 3 states and have never experienced that. I'm sure it happens, but some of it might be med students being a little too sensitive to the hierarchy.

For some reason scrub techs and certain nurses are just irritated by the presence of a student in the OR. Even if they literally do nothing and try to be nice, get all their stuff. They act like you don’t deserve to occupy space in the OR.
It happens more when the surgeon isn’t in the room. I don’t think it’s a sensitivity issue. It’s definitely a real and annoying occurrence.

 

[mehc012]

It's funny, because I read the title thinking "wow, this is me, this will be a useful thread," because I'm currently interested in general surgery, with plans to specialize in trauma or Peds surg, depending on how long I'm willing to play the research/fellowship game...but my last rotation of M3 (Peds) is really tempting me and giving me an identity crisis. Then I read the OP, and somehow despite the similar interests, I feel as if our motivations have little in common.

 

[DrSnips]

Nurses treat residents terrible who they feel will harm their patients or they just don’t like. Doesn’t matter what specialty you are in. I’ve befriended almost every single nurse I’ve ever worked with (even ones all the other residents hate). Just takes work like anything else and good social skills.

You aren’t listing the actual negatives about neonatology:
1) drug parents
2) overall poor social situation
3) patient deaths

While 3) is very rare, 1) and 2) are not and sometimes 3 can be career ending. I’d be more worried about these things than having a nurse yell at you while you are a resident.

I haven't been in a NICU in quite a few years, but are patient deaths really that rare? I would imagine there are always people trying to push the boundaries of prematurity and failing at least some of the time.

 

[Tenk]

I haven't been in a NICU in quite a few years, but are patient deaths really that rare? I would imagine there are always people trying to push the boundaries of prematurity and failing at least some of the time.

Compared to the PICU and ICU, yeah. Many ICUs have a 20%+ mortality.

 

[DrSnips]

Compared to the PICU and ICU, yeah. Many ICUs have a 20%+ mortality.

Right, definitely I know MICU has high mortality. But to me rare means something you won't see often. According to this article that looked at 756 NICUs in the US, there was an average mortality rate of 10.9% in 2017 (which was apparently improved from a prior rate of 14%). That does not sound rare to me if 1/10 babies you see in NICU will die.

 

[Tenk]

Right, definitely I know MICU has high mortality. But to me rare means something you won't see often. According to this article that looked at 756 NICUs in the US, there was an average mortality rate of 10.9% in 2017 (which was apparently improved from a prior rate of 14%). That does not sound rare to me if 1/10 babies you see in NICU will die.

I would wager a lot of those babies that died had little to no chance of survival to begin with which does make it “easier.” I kind of wasn’t talking about those extreme premies but you’re right if you take all cases it is pretty grim. I was more talking about the premies who you generally expect to make it out of the NICU. It is far more rare to get a 28-32 weeker who dies as these usually live albeit sometimes with complications. I know I would feel a lot worse if a baby that has a near 100% survival rate dies as opposed to one that has a 30%. It’s the same why I feel less bad when a 95 year old codes as opposed to a 45 year old. One is expected. The other is unexpected.

 

[PTPoeny]

Gen Surg Pros:
- surgery is cool and i like the OR
- could see myself enjoying my work as a rural general surgeon, or a urgent/trauma surgeon in an urban setting
- definitely felt that the surgery attendings and residents were most similar to me personality wise
- honored it, which i take to mean I show at least some promise in the field

Gen Surg Cons:
- difficult residency
- not great lifestyle afterwards
- i hate the mundane Gen Surg BS such as abscess drains, inheriting trainwrecks from other crappy surgeries, and talking about J tubes vs GJ vs DHT tubes and butt pus almost as much as IM
- annoying elitist culture of the OR floor

NICU Pros:
- cannot imagine a patient population who I would feel more honored and gratified to serve than neonates
-i think attending lifestyle is better than a general surgeon's (but apparently its still not great amongst peds )
- peds residency is cush af
- ties together everything i thought medicine is supposed to be. many good outcomes due to a lot of hard work, some awful outcomes despite a lot of hard work, talking through difficult conversations at family meetings

NICU cons:
- have to suffer through 3 years of pediatrics residency (i generally hate the "medicine" sideof medicine such as long rounding, well person exams, social issues, extensive problem lists etc)
- doctors dont seem as respected in the NICU as compared to surgeons in the OR (although this may soudn petty at first, please see the posts by residents in the Peds forum about how nurses treat them terribly on their NICU rotations)
- easier to automate since it has more thinking than doing

I also had an interest in a surgical field and pediatrics as a 3rd year and spent a lot of time taking to people. I think more people than generally acknowledge it could be happy in multiple areas. If you really could be happy doing either then neither is a "wrong" choice, if that makes sense. It took me a long time as a student to come to that conclusion but made me feel much better.

I do think you need to rotate through peds and NICU before making a choice. If your NICU sub-i is after September 15th you can submit to applications with two sets of letters and two PS and then only take interviews from one specialty after you decide to give yourself another month or so of time.

One other thing, the items that I highlighted in bold are the things that most peds residents (at least at my program) hate about NICU. The NICU generally has the longest rounds in the children's hospital, the worst social issues and the longest problem lists.

The NICU also usually has the highest mortality in the children's hospital too. All the micropreemies and various syndromes that are incompatible with life and neonatal sepsis.

I may be biased but PICU is much cooler We round faster too.

 

[xALIAx]

It's funny, because I read the title thinking "wow, this is me, this will be a useful thread," because I'm currently interested in general surgery, with plans to specialize in trauma or Peds surg, depending on how long I'm willing to play the research/fellowship game...but my last rotation of M3 (Peds) is really tempting me and giving me an identity crisis. Then I read the OP, and somehow despite the similar interests, I feel as if our motivations have little in common.

this is SDN, not your personal blog.

I also had an interest in a surgical field and pediatrics as a 3rd year and spent a lot of time taking to people. I think more people than generally acknowledge it could be happy in multiple areas. If you really could be happy doing either then neither is a "wrong" choice, if that makes sense. It took me a long time as a student to come to that conclusion but made me feel much better.

I do think you need to rotate through peds and NICU before making a choice. If your NICU sub-i is after September 15th you can submit to applications with two sets of letters and two PS and then only take interviews from one specialty after you decide to give yourself another month or so of time.

One other thing, the items that I highlighted in bold are the things that most peds residents (at least at my program) hate about NICU. The NICU generally has the longest rounds in the children's hospital, the worst social issues and the longest problem lists.

The NICU also usually has the highest mortality in the children's hospital too. All the micropreemies and various syndromes that are incompatible with life and neonatal sepsis.

I may be biased but PICU is much cooler We round faster too.

thanks for your post. its actually helpful. yeah i feel like logically surgery makes the most sense for me , the only thing about NICU is the chance to do good by those without a voice. right now i have surgery and nicu subis scheduled before 9/15

 

[mvenus929]

What draws me to Peds is only Neonatology. I had not done Peds yet but have shadowed in NICU. My interest stems from the patient population - I struggled a lot in both IM and Gen Surg with disliking a lot of my patients (because I perceived them as either being demanding, annoying, and/or having put themselves in their situation) This feeling was more so in IM but did occur in Gen Surg. The patient population in NICU just seems very gratifying to work with in comparison (although I am sure family social issues are a whole separate issue)

When I shadowed in the NICU I just felt like it was everything I envisioned medicine as being before Internal medicine crushed that perception. You have to know your physiology, your pharm, your micro in NICU because the babys desparately need you to. Often times on IM I questioned what the point of knowing all that stuff was.

Watching a chest tube get put into a 26 weeker with a tension pneumo was incredible - watching the same procedure on a gomer on IM wanted to make me pull my hair out.

The NICU had an incredible amount of optimism, from decorations of baby names to pictures of babies who had gone on to enter their teens and 20s. IM on the other hand felt like the bowels of a hospital.

NICU Pros:
- cannot imagine a patient population who I would feel more honored and gratified to serve than neonates
-i think attending lifestyle is better than a general surgeon's (but apparently its still not great amongst peds )
- peds residency is cush af
- ties together everything i thought medicine is supposed to be. many good outcomes due to a lot of hard work, some awful outcomes despite a lot of hard work, talking through difficult conversations at family meetings

NICU cons:
- have to suffer through 3 years of pediatrics residency (i generally hate the "medicine" sideof medicine such as long rounding, well person exams, social issues, extensive problem lists etc)
- doctors dont seem as respected in the NICU as compared to surgeons in the OR (although this may soudn petty at first, please see the posts by residents in the Peds forum about how nurses treat them terribly on their NICU rotations)
- easier to automate since it has more thinking than doing

You need to actually experience the NICU. Rounds in the NICU were just as long or longer than the gen peds services in my hospital, in part because we covered more patients, who were generally much sicker.

Peds residency isn't cush... unless you're comparing it to gen surg. Our medical students frequently said we worked harder and longer than any other residency program outside of surgery. This isn't necessarily true everywhere, but it seems like Peds is less likely to have long call/short call like IM, and has just as much (if not more) inpatient time. You're also dealing with sick children, which can be very emotionally draining for some people.

Residents aren't super well respected in the NICU--the attendings generally are. I don't have any experience with fellows, but I imagine it's closer to attendings. The NICU nurses deal with a new batch of residents every month, but often have been taking care of their patients for several months--they're protective. The attendings are there all the time, so they get incorporated into the culture.

tldr: I don't think your shadowing experience was necessarily realistic for the daily grind of the NICU.

You aren’t listing the actual negatives about neonatology:
1) drug parents
2) overall poor social situation
3) patient deaths

While 3) is very rare, 1) and 2) are not and sometimes 3 can be career ending. I’d be more worried about these things than having a nurse yell at you while you are a resident.

I wouldn't say patient deaths are rare in NICU. In my 2 months rotating in the NICU, I had at least 4 deaths (of my patients, not including the other patients on the team that died but I wasn't actively caring for). I think I had 2 in my 2 months in PICU. I didn't have any on any of the gen peds wards teams, and didn't personally have any in the ED. I think the rotation that got close to NICU in terms of mortality was Heme/Onc. Yes, that's rare compared to adult medicine where you're working with the geriatric population, but I wouldn't consider it rare.

 

[Tenk]

You need to actually experience the NICU. Rounds in the NICU were just as long or longer than the gen peds services in my hospital, in part because we covered more patients, who were generally much sicker.

Peds residency isn't cush... unless you're comparing it to gen surg. Our medical students frequently said we worked harder and longer than any other residency program outside of surgery. This isn't necessarily true everywhere, but it seems like Peds is less likely to have long call/short call like IM, and has just as much (if not more) inpatient time. You're also dealing with sick children, which can be very emotionally draining for some people.

Residents aren't super well respected in the NICU--the attendings generally are. I don't have any experience with fellows, but I imagine it's closer to attendings. The NICU nurses deal with a new batch of residents every month, but often have been taking care of their patients for several months--they're protective. The attendings are there all the time, so they get incorporated into the culture.

tldr: I don't think your shadowing experience was necessarily realistic for the daily grind of the NICU.



I wouldn't say patient deaths are rare in NICU. In my 2 months rotating in the NICU, I had at least 4 deaths (of my patients, not including the other patients on the team that died but I wasn't actively caring for). I think I had 2 in my 2 months in PICU. I didn't have any on any of the gen peds wards teams, and didn't personally have any in the ED. I think the rotation that got close to NICU in terms of mortality was Heme/Onc. Yes, that's rare compared to adult medicine where you're working with the geriatric population, but I wouldn't consider it rare.

I admittedly misspoke as from my other post. In my head I was talking about 28+ weekers but didn’t specify that in my post. Most premies above 28 weeks you expect to live. Many premies below 28 weeks you are not surprised to see pass away, sadly. I would say deaths on 28+ weekers are actually rare compared to all other mortality. Technically though, you are correct.

 

[mvenus929]

I admittedly misspoke as from my other post. In my head I was talking about 28+ weekers but didn’t specify that in my post. Most premies above 28 weeks you expect to live. Many premies below 28 weeks you are not surprised to see pass away, sadly. I would say deaths on 28+ weekers are actually rare compared to all other mortality. Technically though, you are correct.

Even so, we see deaths in term babies from NEC and it’s complications, from pulmonary HTN several months into life (not in the initial couple months when all bets are off)... one of the deaths I saw was a termish infant with NEC so bad that they opened him up and subsequently closed him because the entire bowel was necrotic.

And then there’s the babies with severe congenital malformations that we attempt to do things for, but ultimately do comfort care so the families can actually hold the infant.

Yes, deaths in babies are rare. But the NICU gets all those cases super concentrated. Especially if you’re a level 3-4 NICU that has one or more level 2-3 NICUs nearby to manage the less severe cases (the “well” preemies, the sepsis evaluations, the jaundice, the early hypoglycemia, etc).

 

[Tenk]

Even so, we see deaths in term babies from NEC and it’s complications, from pulmonary HTN several months into life (not in the initial couple months when all bets are off)... one of the deaths I saw was a termish infant with NEC so bad that they opened him up and subsequently closed him because the entire bowel was necrotic.

And then there’s the babies with severe congenital malformations that we attempt to do things for, but ultimately do comfort care so the families can actually hold the infant.

Yes, deaths in babies are rare. But the NICU gets all those cases super concentrated. Especially if you’re a level 3-4 NICU that has one or more level 2-3 NICUs nearby to manage the less severe cases (the “well” preemies, the sepsis evaluations, the jaundice, the early hypoglycemia, etc).

I don’t understand your point I guess? Are you arguing this is a good thing? The whole point of my post was that deaths in infants (despite being not nearly as common as adults) are far more distressing and emotionally taxing and are far worse than any of the other negatives the op posted. Are you saying this is false?

 

[mvenus929]

I don’t understand your point I guess? Are you arguing this is a good thing? The whole point of my post was that deaths in infants (despite being not nearly as common as adults) are far more distressing and emotionally taxing and are far worse than any of the other negatives the op posted. Are you saying this is false?

I’m saying that deaths in the NICU aren’t a rare thing, so if you don’t feel like you (you being the OP) can deal with death on a regular basis, the NICU is not the right place to be. And not all the deaths are in the category of “I guess they wouldn’t have made it as long as they did without our intervention anyway” that a lot of people use to distance themselves from the neonatal deaths.

So my post was not arguing against your point, it was adding more evidence to your assertion.

 

[mehc012]

this is SDN, not your personal blog.

Sorry that I made a comment that took up all of 3s of your time to read?
I found it interesting to find someone else who is having difficulty with the exact same decision as I was, at the same time, but for completely different, almost opposite reasons. Perhaps I even figured you might find it interesting to hear a different perspective on the same conundrum, but didn't want to accidentally hijack this thread into advice for me, and so was offering you the chance to either ignore or solicit that different take. Silly me.

 

[DokterMom]

Sorry that I made a comment that took up all of 3s of your time to read?
I found it interesting to find someone else who is having difficulty with the exact same decision as I was, at the same time, but for completely different, almost opposite reasons. Perhaps I even figured you might find it interesting to hear a different perspective on the same conundrum, but didn't want to accidentally hijack this thread into advice for me, and so was offering you the chance to either ignore or solicit that different take. Silly me.

Sounds like Path might be the better place... 😵

 

[OrthoTraumaMD]

Sorry that I made a comment that took up all of 3s of your time to read?
I found it interesting to find someone else who is having difficulty with the exact same decision as I was, at the same time, but for completely different, almost opposite reasons. Perhaps I even figured you might find it interesting to hear a different perspective on the same conundrum, but didn't want to accidentally hijack this thread into advice for me, and so was offering you the chance to either ignore or solicit that different take. Silly me.

The best is when a person who has been a member for like 3 days makes an “SDN defining” comment.

 

[MEN2C]

Peds Surgery and NICU are very very very different. I’m a NICU fellow, here is my perspective:

1. Peds residency is cush only compared to G surg residency. You can expect to hit close to the 80 hour mark on most inpatient rotations. G. Surg is much more brutal in terms of workload while you’re there.
2. Peds and then neonatology are not difficult to match into. G surg is not particularly difficult (though it is more difficult than pediatrics for sure) but peds surgery is VERY DIFFICULT.
3. NICU fellowship is a lot of hours but you also have 2 years of research built into a 3 year fellowship. I find it easier than residency. On the other hand, Peds surgery fellowship is the most brutal training I have ever imagined. They are on call literally all the time from home (on home call doesn’t count towards 80 hours). I am sure I couldn’t do it.
4. I haven’t had any problems with “being respected” as a fellow. A NICU nurse, the primary for a particular patient, can take care of a little baby for months on end - doing everything from changing their diapers, holding them when they cry, sticking them for labs, etc. You’d have to be inhuman not to become protective of that baby when some new person comes in and does stuff. You have to earn it as a resident. Trust me, the experienced NICU nurses know a lot and being humble as a resident and willing to learn from people will go a long way instead of being focused on “respect”.
5. NICU has lots of procedures (intubations, chest tubes, UAC/UVC, PICC, and some rarer ones) but peds surgery obviously has a lot more and has really cool and amazing surgeries too. They are true general surgeons - you mostly don’t have the adult type general surgical sub specialists at most places. You could be resecting bowel, cannulating for ECMO, fixing esophageal atresia, removing a tumor, running a trauma, and taking out an appendix, and a bunch of other things - all in the same week. I truly believe it’s one of the best specialties that encompasses both a wide spectrum of “thinking” AND a wide spectrum of “doing”. A great combo of both head and hands. I think they have an amazing set of skills and an amazing job. Of course, I didn’t like the OR and although I could have matched general surgery, there was no way I was gonna be competitive enough for peds surgery (not to mention my wife would 100% have divorced me if I did general surgery residency —> peds surgery fellowship). I'm definitely in awe of those guys though.
6. You have to be comfortable in neonatology with deaths and counseling both prenatally and post natally. I spend a lot of time time in family meetings discussing withdrawals or goals of care or prenatally, going over likely neurodevelopmental outcomes as well as goals of care. You develop your style but it never gets easy to walk over from a resuscitation bed and tell a mom who just gave birth 15 minutes ago that their newborn baby is dying or dead, and it's time to hold them.
7. Neonatology has a lot of medicine but it is limited set of problems that usually appear. There are probably 10 problems that are your bread and butter and another 25 that are common but less frequent. Of course, you always have a baby in the unit (assuming a large level III/IV referral center) with some crazy genetic issues which can present with any symptom - from glucose of 1800 to a tumor to pancreatitis to conjoined twins (try figuring out dosages for conjoined twins where only one twin has a problem 😳) to a weird metabolic disorder. But those are sporadic.
8. For what it’s worth, I love my job. Bringing an unexpected limp and apneic baby back to life with an intubation and maybe a chest tube or two feels GREAT. Especially when they go home in RA and you see them completely normal at your follow up visits. I love my patients. How many specialties can truly say that? And yes, i even love the parents. For every parent you get that is abusive or neglectful, you get 50 that love their kids and are grateful for what you do. You get to help save their newborn baby! I mean, how cool is that? Unlike in some specialties where you do a lot of important things but it’s hard to feel in the moment that you’re making a huge difference long term to a patient. For example, in residency, when I vaccinated in my gen peds clinic - I KNOW in the abstract that this intervention is saving lives beyond a shadow of a doubt (and arguably is of greater benefit to society than resuscitating a 23 week baby) but it’s hard to get an adrenaline rush from ordering a HPV vaccine...whereas in the NICU, you pretty much KNOW this 23 weeker would have died if you weren’t there (ie if he was born at home) and to me, that rush you get (especially when it goes well) is a great feeling. Though to be fair, peds surgery does a lot of saving kids too , so that’s not really a distinction.